Serial measurement of pancreatic stone protein for the early detection of sepsis in intensive care unit patients: a prospective multicentric study

Abstract

Background The early recognition and management of sepsis improves outcomes. Biomarkers may help in identifying earlier sub-clinical signs of sepsis. We explored the potential of serial measurements of C-reactive protein (CRP), procalcitonin (PCT) and pancreatic stone protein (PSP) for the early recognition of sepsis in patients hospitalized in the intensive care unit (ICU). Methods This was a multicentric international prospective observational clinical study conducted in 14 ICUs in France, Switzerland, Italy, and the United Kingdom. Adult ICU patients at risk of nosocomial sepsis were included. A biomarker-blinded adjudication committee identified sepsis events and the days on which they began. The association of clinical sepsis diagnoses with the trajectories of PSP, CRP, and PCT in the 3 days preceding these diagnoses of sepsis were tested for markers of early sepsis detection. The performance of the biomarkers in sepsis diagnosis was assessed by receiver operating characteristic (ROC) analysis. Results Of the 243 patients included, 53 developed nosocomial sepsis after a median of 6 days (interquartile range, 3–8 days). Clinical sepsis diagnosis was associated with an increase in biomarkers value over the 3 days preceding this diagnosis [PSP (p = 0.003), PCT (p = 0.025) and CRP (p = 0.009)]. PSP started to increase 5 days before the clinical diagnosis of sepsis, PCT 3 and CRP 2 days, respectively. The area under the ROC curve at the time of clinical sepsis was similar for all markers (PSP, 0.75; CRP, 0.77; PCT, 0.75). Conclusions While the diagnostic accuracy of PSP, CRP and PCT for sepsis were similar in this cohort, serial PSP measurement demonstrated an increase of this marker the days preceding the onset of signs necessary to clinical diagnose sepsis. This observation justifies further evaluation of the potential clinical benefit of serial PSP measurement in the management of critically ill patients developing nosocomial sepsis. Trial registration The study has been registered at ClinicalTrials.gov (no. NCT03474809), on March 16, 2018. https://www.clinicaltrials.gov/ct2/show/NCT03474809?term=NCT03474809&draw=2&rank=1.

Pancreatic Stone Protein as a Biomarker for Sepsis at the Emergency Department of a Large Tertiary Hospital

“…It could be that statistical differences were erased due to this limitation. To resolve this, we also used dichotomized values for PSP based on Youden’s index, the value of which was 199 ng/mL (after excluding COVID-19 patients), in line with previous literature [ 39 ]. In addition, PSP was compared with CRP and WBC but not with procalcitonin (PCT).…”

“…A final limitation is that we used single PSP measurements. Some studies showed promising results using serial measurements of PSP and corresponding dynamic analyses [ 39 ]. This approach might be more usable, especially in complex hospital populations.…”

Accuracy of pancreatic stone protein for the diagnosis of infection in hospitalized adults: a systematic review and individual patient level meta-analysis

“…The benefit of serial measurement of PSP for the early detection of sepsis in intensive care unit patients has been evaluated in a prospective trial using the new POC technology [ 32 ]. This patient population would be the first ideal cohort to validate the defined threshold in a homogenous patient population as well as the value of combining PSP to CRP.…”

Pancreatic Stone Protein: Review of a New Biomarker in Sepsis

“…The performance of PSP as a biomarker of infection and sepsis has been evaluated in several patient populations and clinical settings [34,[41][42][43][44][45][46][47]-Table 1.…”